Psychological resilience in pediatric nurses: a cross-sectional survey

Introduction

With the advancement of positive psychology, psychological resilience has emerged as a focal point in global psychological research, defined as an individual’s capacity to mobilize internal and external resources to adapt, recover, and grow in the face of adversity (1,2). This dynamic process—encompassing cognitive, emotional, and behavioral adjustments—enables individuals to navigate stressors while maintaining psychological equilibrium, making it a critical construct in understanding human adaptation to challenging environments (3). For healthcare professionals, and particularly nurses, resilience serves as a protective factor: high resilience levels correlate with reduced anxiety and depression, enhanced coping efficacy, and greater confidence in managing workplace demands (4). In clinical settings, resilience is increasingly recognized as a cornerstone of nurses’ ability to withstand the physical and emotional toll of caregiving, directly influencing their capacity to deliver consistent, high-quality services (5,6). Extant literature has established robust associations between nurses’ psychological resilience and key occupational outcomes. Studies indicate that resilience mitigates turnover intentions, improves job satisfaction, and buffers against burnout across diverse nursing specialties (7,8). However, these findings remain largely generalized, with critical gaps in understanding resilience within specialized contexts—particularly pediatric nursing. Pediatric nurses operate in uniquely demanding environments, characterized by the emotional intensity of caring for vulnerable children, stringent clinical standards, and often heightened parental expectations (9). Compared to their counterparts in other departments, they face elevated psychological strain, which not only erodes work engagement and increases turnover rates but also manifests in mental health challenges such as anxiety, sleep disturbances, and depression (10). Against this backdrop, addressing the psychological resilience of pediatric nurses emerges as a critical imperative—one that bears relevance for global healthcare systems striving to enhance workforce sustainability and patient care standards.

Despite this urgency, research specifically focused on pediatric nurses’ resilience remains limited. Existing studies are often constrained by small sample sizes, single-center designs, or narrow geographic scopes, limiting generalizability. Broader nursing resilience research, while insightful, frequently overlooks variables unique to pediatric settings—such as the impact of prolonged exposure to pediatric illness or grief—and rarely addresses how resilience interacts with factors like professional development, workplace support, or compensation structures in this cohort. This gap is consequential: without a clear understanding of pediatric nurses’ resilience profiles and their determinants, targeted strategies to support this workforce remain underdeveloped. Occupational health management for pediatric nurses thus stands at a critical juncture. While general interventions (e.g., stress reduction programs, mentorship) have shown promise in enhancing resilience across nursing populations, their applicability to pediatric contexts remains untested. There is a pressing need to identify which factors—demographic, occupational, or environmental—most strongly influence resilience in this group, as well as how these factors interact to shape adaptive capacities. By addressing these knowledge gaps, this study aims to inform evidence-based strategies that not only bolster pediatric nurses’ psychological resilience but also strengthen workforce sustainability and care quality in pediatric healthcare settings.

Therefore, this study aimed to evaluate the psychological resilience of pediatric nurses and identify key factors influencing their resilience, to provide evidence for nurse management and care. We present this article in accordance with the STROBE reporting checklist (available at https://tp.amegroups.com/article/view/10.21037/tp-2025-390/rc).

Methods

The study was a cross-sectional survey design. This study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. The study protocol has been meticulously reviewed and granted approval by the Children’s Hospital of Nanjing Medical University’s ethics committee (approval No. 202509027-1). Prior to participation, written informed consent was obtained from every participant, ensuring their voluntary and informed agreement. The data gathered were exclusively utilized for the purposes of this study.

This cross-sectional study was conducted between June 1, 2024 and July 31, 2024, among pediatric nurses at a tertiary children’s hospital in Jiangsu Province, China. The design aimed to explore the levels of psychological resilience and identify its associated factors in this cohort, with data collected via structured questionnaires to ensure standardization and comparability.

A convenience sampling method was used to recruit participants. Inclusion criteria were: (I) registered nurses currently employed in pediatric departments; (II) at least 6 months of clinical experience in pediatric nursing to ensure familiarity with the work environment. Exclusion criteria included: (I) nursing interns or trainees; (II) nurses on long-term leave (≥1 month) during the data collection period, as their work engagement might not reflect typical conditions.

Sample size was determined based on the methodological principle that “the minimum sample size should be 15–20 times the number of analyzed variables” (11). In this study, 9 independent variables were identified for analysis. Using the upper end of the recommended range (20 times the number of variables) to ensure statistical power, the baseline sample size was calculated as 9×20=180. To account for potential invalid responses (e.g., incomplete questionnaires, logical inconsistencies), a 20% attrition rate was incorporated, resulting in a final required sample size of 180×1.2=216. This ensured the study would have sufficient statistical robustness to detect meaningful associations.

Data were collected using self-administered questionnaires distributed by trained research assistants. Prior to participation, nurses were provided with detailed information about the study’s purpose, procedures, and confidentiality measures. Informed consent was obtained, emphasizing voluntary participation and the right to withdraw at any time. Participants completed the questionnaires independently, with an estimated completion time of 10–15 minutes to minimize disruption to clinical workflows.

Collected variables included:

• Demographic characteristics: gender, age, marital status, number of children;
• Occupational characteristics: years of work experience, professional title (junior nurse, nurse practitioner, nurse in charge, deputy chief nurse, chief nurse), education level (associate degree, bachelor’s degree, master’s degree), average monthly income, working department (e.g., internal medicine, surgery, neonatology).

This study utilized the Psychological Resilience Scale developed and validated by scholar Yu et al. (12) for assessment. The scale comprises three dimensions with a total of 25 items, specifically including tenacity (13 items), strength (8 items), and optimism (4 items). Each item is rated on a 5-point Likert scale, ranging from “Never” to “Always”, with scores from 0 to 4, where higher scores indicate a higher level of psychological resilience. The maximum possible score for the scale is 100 points, and the levels of psychological resilience are categorized into three tiers based on the scores: low (0–56 points), moderate (57–70 points), and high (71–100 points). Previous research has indicated that the scale has a Cronbach’s α coefficient of 0.91, demonstrating good reliability and validity (13).

During the clinical nursing questionnaire survey process, we initially provided a comprehensive explanation to the nurses regarding the purpose and background of the survey, ensuring that every participant fully understood the significance and importance of the study. Subsequently, we detailed the questionnaires or scales used, including their development background, structural composition, and scoring methods, giving the nurses a clear understanding of the assessment tools. We placed special emphasis on the participants’ right to informed consent, ensuring that each nurse was aware of the voluntary nature and anonymity of the survey, as well as the confidentiality of the information they provided. The time required for each nurse to complete the questionnaire was estimated to be between 10 to 15 minutes, a duration that considered both the length of the questionnaire and the busy schedules of the nurses’ daily work, striving to collect data without disrupting their normal duties. After the collection of questionnaires, we will conduct a review and cleaning of the data, excluding any invalid or incomplete questionnaires, to ensure the accuracy and reliability of the data.

Statistical analysis

Data analysis was performed using SPSS 24.0 software. Quantitative data are presented as mean ± standard deviation, with group differences assessed using independent samples t-tests for binary variables and one-way analysis of variance (ANOVA) for categorical variables with three or more groups. Pearson correlation coefficients were calculated to examine bivariate relationships between demographic/occupational characteristics and total psychological resilience scores. For multiple linear regression analysis, variables demonstrating statistically significant associations in the correlation analysis (P<0.20) were included as potential predictors in the initial model to avoid excluding relevant factors; a stepwise regression method was then applied to refine the model, retaining only those variables that contributed significantly to explaining variance in resilience (final model P<0.05). Standardized β coefficients were reported for significant predictors in the regression model to indicate the relative strength of each factor’s association with resilience. All statistical tests were two-sided, with P<0.05 considered statistically significant.

Results

Four hundred and six pediatric nurses were finally included in the survey. As presented in Table 1, Among the nurses included in the study, females constituted the vast majority. The average age of these nurses was 32.08 years old. Their average years of work experience was 12.14 years with a standard deviation of 5.30 years, reflecting a wealth of clinical experience. In terms of professional titles, the majority were nurse practitioners, and in terms of educational background, the majority of nurses held a bachelor’s degree.

As shown in Table 2, the total score for psychological resilience among pediatric nurses was 59.23, with a standard deviation of 10.82, indicating that the overall level of psychological resilience among pediatric nurses is at a moderate level. In this survey, the average score for each item was 2.38, with a standard deviation of 0.45. The average scores for the dimension items, ranked from highest to lowest, were strength, tenacity, and optimism, reflecting the differences in the nurses’ performance across various dimensions of psychological resilience. As presented in Table 1, there were statistical differences in the psychological resilience score among pediatric nurses with different age, years of work experience, professional title, education level and average monthly income (all P<0.05).

As shown in Table 3, Pearson correlation analysis found that several factors are linked to higher psychological resilience scores among the included pediatric nurses (all P<0.05): older nurses tend to have greater resilience (r=0.570), those with more years of work experience show higher resilience (r=0.515), nurses with higher professional titles report greater resilience (r=0.607), higher education levels correlate with stronger resilience (r=0.563), and higher average monthly income is associated with greater resilience (r=0.625).

Table 4 presents the results of the multivariate linear regression analysis, which identified age, years of work experience, professional title, education level, and average monthly income as independent predictors of psychological resilience among pediatric nurses (all P<0.05). The model explained 36.8% of the variance in resilience scores (adjusted R²=0.368, F=15.221, P<0.001). Specifically, education level showed the strongest association with resilience (β=0.138, P=0.007), followed by age (β=0.209, P=0.03), professional title (β=0.105, P=0.01), average monthly income (β=0.104, P=0.002), and years of work experience (β=0.117, P=0.040). Each variable contributed significantly to resilience levels even when controlling for the effects of the other predictors in the model. The constant term of the regression equation was 50.329 (P=0.002), indicating the estimated baseline resilience score when all predictors are set to zero.

Discussion

Pediatric nursing demands not only a robust foundation in theoretical knowledge but also extensive clinical proficiency (14). Amidst high occupational risks and intense work pressure, mental health challenges among pediatric nurses have become increasingly salient. Psychological resilience—defined as an individual’s capacity to endure adversity and recover psychologically—functions as a stable personal trait that mitigates the detrimental effects of stress and adverse events (15,16). The current study reveals that pediatric nurses exhibit a generally moderate level of psychological resilience, aligning with findings from prior research (17,18). Notably, their resilience levels are relatively lower compared to general nurses in comprehensive hospitals (19), a discrepancy that may stem from the unique stressors inherent to pediatric care (e.g., emotional demands of caring for vulnerable children, heightened parental expectations) and relatively lower income levels (20,21). This observation underscores the urgency for clinical nursing managers to prioritize targeted support for the pediatric nursing workforce, including policy interventions that address both structural stressors (e.g., workload, compensation) and psychological needs. Such measures are critical to fostering their mental well-being and sustaining their professional development in a high-stakes care environment.

As nurses accumulate years and experience in their profession, they often exhibit a more mature and stable mindset. Their composure and strategic responses to various clinical nursing challenges stem from extensive practice and learning (22). This wealth of experience enables them to handle emergencies and complex cases with greater ease, making swift judgments and implementing effective nursing interventions (23). Furthermore, as their years of service increase, the various difficulties and challenges encountered throughout their careers have also honed their psychological resilience (24). They have learned to remain calm under pressure, to seek solutions in adversity, and to recover and adjust their mindset quickly after setbacks. This psychological resilience not only aids in their personal professional development but also positively impacts the work efficiency of the entire nursing team and the quality of patient care (25,26). Therefore, senior nurses play a vital role within the team. Their experience and psychological stability are crucial for mentoring new nurses, passing on nursing knowledge and skills, and fostering a positive and uplifting work environment.

In the field of medical nursing, nurses with higher professional titles often enjoy a more stable work status due to their extensive experience and profound professional literacy. The calm mindset they demonstrate at work stems not only from their confidence in professional skills but also from the long-term accumulation of clinical experience and a deep understanding of nursing work. These senior nurses can remain calm and focused when dealing with various clinical challenges, handling complex issues efficiently and orderly (27,28). Moreover, nurses with higher professional titles typically receive more generous benefits at work. These benefits may include but are not limited to higher salaries, more comprehensive social insurance, more career development opportunities, and more flexible work schedules (29). These benefits not only improve their quality of life but also enhance their job satisfaction and happiness, thereby bringing more sense of achievement and pleasure in their work (30). Thanks to this positive working environment and mindset, nurses with higher professional titles often have greater psychological resilience. They can effectively cope with work pressure, maintain emotional stability, recover quickly from setbacks, and face various challenges in their career with a positive attitude (31,32).

There exists a significant positive correlation between the academic qualifications of pediatric nurses and their psychological resilience. In-depth research (33) has uncovered an intriguing phenomenon: nurses with higher academic degrees typically possess greater autonomy in their work and have access to a richer array of psychological support resources. This support stems not only from their professional knowledge and skills but also from the recognition and respect of their peers, as well as the trust and authorization from management. Due to the advantages of their educational background, these highly educated nurses often have a firm confidence in their abilities, enabling them to remain calm and decisive when facing challenges and difficulties at work (34). They can apply their professional knowledge and critical thinking to analyze problems and identify effective solutions. Furthermore, nurses with higher academic qualifications are often exposed to a broader social network and resources throughout their careers (35). These resources encompass not only the latest updates in their field and opportunities for academic exchange but also professional connections and collaborative opportunities within the industry. These social resources provide them with a wider range of perspectives and methods for dealing with problems encountered at work, enhancing their adaptability and problem-solving capabilities (36).

Pediatric nurses with higher income levels exhibit greater psychological resilience, which is consistent with previous research findings (37,38). The positive correlation between income and resilience can be attributed to the fact that higher earnings significantly enhance nurses’ job enthusiasm and professional satisfaction (39). Specifically, a higher income level provides nurses with more resources and autonomy, enabling them to face work challenges and difficulties with increased confidence. Moreover, nurses with higher incomes tend to have access to broader social resources and psychological support, which aids in demonstrating stronger adaptability and problem-solving capabilities when encountering work-related issues (40). To further enhance the psychological resilience of pediatric nurses, multiple approaches can be implemented. For instance, encouraging nurses to improve their educational level not only strengthens their professional competencies but also reflects the value of their labor, thereby increasing their income levels (41). Additionally, offering professional training and career advancement opportunities can assist nurses in achieving a greater sense of accomplishment and satisfaction in their work, which in turn contributes to bolstering their psychological resilience (42,43).

While this study provides meaningful insights into pediatric nurses’ psychological resilience, it is important to acknowledge several limitations that constrain its scope and interpretation. First, the single-center design—confined to a single hospital—restricts the generalizability of findings by failing to capture critical demographic and regional variations, such as differences between urban and rural healthcare settings or across diverse healthcare systems. This narrow sampling frame limits the extent to which results can be extrapolated to broader pediatric nursing populations. Methodologically, the cross-sectional nature of the study precludes the establishment of causal relationships. For instance, while income and resilience are correlated, the directionality remains unresolved: it is unclear whether higher income directly enhances resilience or if greater resilience facilitates professional advancement (and thus higher earnings). Such bidirectional dynamics highlight the need for longitudinal designs to disentangle cause and effect. Additionally, the analysis omits key variables identified in prior research as influential to nurses’ resilience, including social support systems, work-family conflict, workplace violence, and personal coping styles. These oversights may limit the completeness of our understanding of resilience determinants in this cohort. Furthermore, the underrepresentation of male nurses (3.94%, n=16) introduces potential gender bias, as the sample overemphasizes female experiences and precludes analysis of gender-specific resilience patterns.

Addressing these limitations requires future research to adopt multi-center designs that encompass diverse geographic and institutional contexts, enabling replication of observed correlations (e.g., between education and resilience) across broader populations. Expanded variable frameworks should integrate the omitted factors noted above, while longitudinal or interventional approaches could clarify causal mechanisms—for example, by examining how interventions like mindfulness training or mentorship programs impact long-term resilience. Additionally, subgroup analyses across pediatric sub-departments (e.g., neonatology versus emergency care) and investigations into interactions between nurses’ chronic illness status and identified predictors would further enrich our understanding of this complex construct.

Conclusions

In summary, the psychological resilience levels of pediatric nurses are generally moderate. Key independent factors influencing these levels include age, years of professional experience, professional titles, educational qualifications, and average monthly income. To enhance the psychological resilience of pediatric nurses, the nursing administrators should encourage nurses to pursue advanced education, such as through specialized-to-bachelor’s degree programs, master’s degree studies, or other continuing education avenues. Hospitals with the capacity to do so could provide appropriate learning spaces and resources to support the professional development and academic aspirations of nurses. Besides, establishing a performance-based management system is crucial. By linking employees’ benefits, career advancement opportunities to individual performance, it is possible to more accurately motivate nurses’ enthusiasm and innovation at work. Additionally, it is recommended that bonuses be distributed regularly based on individual performance assessments to increases nurses’ job motivation and satisfaction, thereby fostering greater psychological resilience in their professional roles.

Acknowledgments

None.

Footnote

Reporting Checklist: The authors have completed the STROBE reporting checklist. Available at https://tp.amegroups.com/article/view/10.21037/tp-2025-390/rc

Data Sharing Statement: Available at https://tp.amegroups.com/article/view/10.21037/tp-2025-390/dss

Peer Review File: Available at https://tp.amegroups.com/article/view/10.21037/tp-2025-390/prf

Funding: None.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tp.amegroups.com/article/view/10.21037/tp-2025-390/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. This study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. The study has been reviewed and approved by the ethics committee of Children’s Hospital of Nanjing Medical University (approval No. 202509027-1). And written informed consent was obtained from all participants.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

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